Depression after a stroke is 35 times more deadly than its absence, according to an analysis of National Health and Nutrition Examination Survey data.

As many as one in three stroke survivors have depression. To find out how such depression relates to all-cause and stroke mortality, a team lead by Ali Razmara, MD, conducted a study published in the Journal of Stroke and Cerebrovascular Disorders that used data from the nearly 10,000 participants in the National Health and Nutrition Examination Survey I Epidemiologic Follow-Up Study that was conducted during 1982-1992.

Specifically, they stratified the 9,919 participants who were interviewed in 1982-1984 into four groups on the basis of their self-reported stroke and depression, defined as Center for Epidemiologic Studies Depression (CES-D) scale score of 16 or higher. The groups either had no stroke and no depression (reference group), stroke and no depression, no stroke and depression, or both stroke and depression. A total of 121 (1.2%) reported prior stroke.

The youngest participants, aged 25-64 years, showed no significant association between stroke or depression, or both, and all-cause mortality. In those aged 65-74 years, however, all-cause mortality was significantly affected by not only depression alone and stroke alone, with adjusted hazard ratios 1.24 and 1.64, respectively, but also by the combination of depression and stroke (adjusted HR, 2.28), “consistent with an additive relationship,” said Dr. Razmara, a neurologist at Kaiser Permanente in Irvine, Calif.

Furthermore, in that same age group, having depression after a stroke boosted stroke mortality by a factor of 35, compared with stroke survivors without depression (adjusted HR, 35.33). This striking difference highlights “the importance of identifying and treating depression among stroke survivors,” the investigators concluded.

The Roxanna Todd Hodges Foundation sponsored the study. No competing interests were reported.